Shared-care planning OSCE — multi-level co-management and loop closure

Station A — Fragmented multi-level discharge (10 minutes)

Setup. Actor parent of a 7-year-old with medical complexity after ward admission. Five specialties, unsorted letters, mother only coordinator. Child currently stable. [9] [1]

Tasks for candidate

1. Assess the shared-care network and identify failing domains. [8]
2. Explain why parent-courier care is unsafe without blaming the family. [1]
3. Co-create a shared-care plan with named owners and emergency thresholds. [7] [9]
4. State concrete loop-closure actions before discharge. [6] [2]

Expected performance

• Names primary/secondary/tertiary teams and outstanding loops. [8]
• Defines shared care versus one-way referral. [2]
• Writes owners, review date, thresholds; reconciles medicines/devices. [7] [9]
• Arranges timed medical-home/coordinator follow-up and specialty feedback routes. [6]
• Uses plain language and teach-back; offers support without dumping unpaid labour. [9] [7]

Critical fails

• Delays ABCDE if instability appears. [13]
• Blames mother as the problem. [1]
• Gives only “see your GP sometime” with no owners. [8]

Station B — Oncology shared care and transition counselling (10 minutes)

Setup. Actor parent of a child entering maintenance oncology care far from the tertiary centre; second phase is a 16-year-old multi-specialty patient without adult plan. [5] [10]

Tasks

1. Explain hub-and-spoke shared care principles and safety conditions. [4] [5]
2. Describe communication expectations between regional and tertiary teams. [5] [2]
3. Outline multi-level transition steps for the adolescent scenario. [10]

Expected performance

• Tertiary protocol leadership with regional delivery where safe. [4] [5]
• Explicit emergency pathways and result ownership. [4] [5]
• Transition: prepare, transfer with overlap, integrate into adult primary and specialty care. [10]
• Equity: travel, cost and cultural safety addressed. [5] [7]

Critical fails

• Promises local care with no tertiary link. [4]
• Birthday-only transition. [10]
• Leaves family as sole courier between centres. [1]

Examiner checklist

• Stabilise-first rule stated if acute threat [13]
• Shared care defined with named owners and closed loops [2]
• Parent intermediary risk explained without blame [1]
• Written plan elements listed [7]
• Hub-and-spoke oncology principles accurate [4] [5]
• Multi-level transition described [10]
• Clear, family-centred communication [7]